THORACIC WALL

LECTURE 7

Syed Farhad Ali

Lecturer Radiology
Professional college of Medical Sciences,
Peshawar
Diaphragm
The diaphragm is a thin muscular septum/ skeletal
muscle that separates the chest cavity above from the
abdominal cavity below. Structures that passes
between the thoracic and abdominal cavities (e.g
esophagus, aorta)
Must pierce the diaphragm.
The diaphragm is the most important muscle of
respiration. It is dome shaped and consists of a
peripheral muscular part, which arises from the
margins of the thorax and centrally place tendons.
Division of the Origin of the diaphragm
The origin of the diaphragm can be divided into 3 parts
1. Sternal part
2. Costal part
3. Vertebral part
1.Sternal Part
The sternal part of the diaphragm arising from the
posterior surface of the Xiphoid process
2.Costal Part
The costal part of the diaphragm arising from the inner
surface of the lower six ribs and their costal cartilages.
3.Vertebral Part
The vertebral part of the diaphragm arising by the
vertebral columns(crura) and from the arcuate
ligaments.
Crura of the diaphragm
The crus of diaphragm (pl. crura), refers to one of two 
tendinous structures that extends below the 
diaphragm to the vertebral column. There is a right
crus and a left crus, which together form a tether for
muscular contraction. They take their name from their
leg-shaped appearance – crus meaning leg in Latin.
Right Crus
The right crus, larger and longer than the left, arises
from the front of the bodies and intervertebral
fibrocartilages of the upper three lumbar vertebrae.
Left Crus
The left crus arises from the upper sides of the bodies of
the first two lumber vertebrae and the inter vertebral
disc
Arcuate Ligments
 A thickening of the fascia of the lumbar quadrate
muscle
1.Lateral Arcuate Ligments
2.Medial Arcuate Ligments
Quadratus lumborum (QL)
The quadratus lumborum (QL) is the deepest
abdominal muscle. It's located in your lower back on
either side of the lumbar spine. It starts at your lowest
rib and ends at the top of your pelvis. It's common to
have pain here because you use this muscle to sit,
stand, and walk
1.Lateral Arcuate Ligments

The lateral arcuate ligament runs from the front of the

transverse process of the first lumbar vertebra,
and, laterally, to the tip and lower margin of the
twelfth rib. It forms an arch over the quadratus
lumborum muscle
2.Medial Arcuate Ligments

The medial arcuate ligments extends from the side of

the body of the second lumber vertebra to the tip of
the transverse process of the first lumber vertebra.
Shape of Diphragm
The diaphragm, located below the lungs, is the major
muscle of respiration. It is a large, dome-shaped
muscle that contracts rhythmically and continually,
and most of the time, involuntarily. Upon inhalation,
the diaphragm contracts and flattens and the chest
cavity enlarges.
As seen from in front , the diaphragm curves up
into left and right dome (cupulae) . The right
dome reaches as high as the upper border of
the 5th rib, and the left dome may reach the
lower border of the 5th rib. The right dome lies at
a higher level because of the large size of the
right lobe of the liver. The central tendon lies at
the level of xiphisternal joint. The dome support
the right and the left lungs, where as the central
tendon supports the heart.
The level of diaphragm varies with the phase of
respiration. The posture and the degree of distention
of the abdominal visceras. The diaphragm is lower
when the person is sitting or standing. It is higher in
supine position and after a large meal.
When seen from the side the diaphragm has the
apperiance of an inverted “J” shape with the long limb
extending up from the vertebral column and the short
limb extending forward to the xiphoid process.
Nerve supply of Diaphragm
Two types of nerves supply the diaphragm
1. Right Phrenic nerve
2. Left Phrenic nerve
Motor nerve supply comes from the right and left
phrenic nerves(c3,c4,c5). Each phrenic nerve supplies
about half of the diaphragm. Thus functionally the
diaphragm operates as two hemi diaphragms.
For sensory nerve supply, the Phrenic nerves supply the
parital pleura and peritoneum covering the central
surfaces of the diaphragm. The lower intercostal
nerves supply the periphery of the diaphragm.
Diaphragmatic Action
1. Inspiration
2. Expiration
Openings of the Diaphragm
The diaphragm has 3 main openings
1. Aortic opening
2. Esophagial opening
3. Caval opening
1.Aortic opening
Aortic opening lies anterior to the body of the 12 th
thoracic vertebra and between the crura. It transmits
1. Aorta
2. Thoracic duct
3. Azygos vein
2.Esophageal opening
Esophageal opening lies at the level of the 10 th thoracic
vertebra In the sling of muscle fibers derived from the
right crus. It transmits
1. Esophagus
2. Right and left Vagus nerves
3. the Esophageal branches of the left gastric vessels
4. Lymphatics from the lower 3rd of the esophagus
3.Caval opening
The caval opening lies at the level of the 8th thoracic
vertebra, in the central tendon.
It transmits
1. Inferior Vana cava
2. Terminal b ranches of the right Phrenic nerve.